Portable X-Ray

Certification Survey

In order to participate in the Medicare program, a certification survey must be performed by HSS. The surveyor will inspect equipment, interview staff members, and review documents to evaluate the extent to which Conditions for Coverage are met.

If the owner of the portable x-ray equipment is not a physician, the supplier must provide certification, as described in §486.102 (a)(2) completed by a supervising physician that is qualified in accordance with §486.102 (b) of the Conditions for Coverage.

New suppliers must be in operation and providing services to patients when surveyed for certification. No fees are required.

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It is critical to begin the process by submitting an application for Medicare enrollment through the designated MAC (Medicare Administrative Contractor). This is generally a lengthy process and must be completed before the State Agency and CMS can continue with certification. To apply for enrollment, the applicant must have an assigned NPI (National Provider Identifier) issued by the National Plan and Provider Enumeration System (NPPES).

The MAC for Portable X-Ray Suppliers in Louisiana is Novitas Solutions. The Novitas website provides options for enrolling online and/or by mail.

The Application for Medicare Enrollment for Portable X-Ray Suppliers is the 855B (which may also be accessed through the Novitas website).

Once notification of an approved recommendation for enrollment has been received from Novitas (i.e., the "MAC Recommendation Letter"), the process can continue. Although Novitas will issue a copy of the letter and the completed 855B to the State Agency (SA) directly, the supplier may wish to submit to SA a copy of the letter received, with the completed Application for Certification (form CMS1880) and a Letter of Intent.

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The documents required to schedule an initial certification survey should be submitted to Debby.Franklin@LA.GOV

Federal Regulations and Guidelines

Title 42 of The Electronic Code of Federal Regulations (e-CFR) lists the
Conditions for Coverage of Portable X-Ray Suppliers in Part 486, Subpart C.

The Medicare State Operations Manual, Appendix D, contains information about the survey process and interpretive guidelines of federal regulations.

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Change of Ownership Information

Providers must complete this document when they have a change in their ownership structure. This document would be used for both a change of ownership (CHOW) as defined by state and/or federal regulations, or a change of ownership information (CHOI) that does not meet the state and/or federal regulations CHOW definition.

 For Health Standards to make a CHOW/CHOI determination, all providers must submit the following documents:

1. *Letter of Intent (including d/b/a and entity name of the previous and the new owner, the effective date of transfer of ownership, address and phone number)
2. *A diagram showing the ownership structure “before” and “after” the change
3. *Copy of the executed Bill of Sale
4. *CHOW/CHOI License Application
5. *855A/B approval letter for the following providers: Home health, hospice, hospitals, RHCs, ASCs,   

ESRDs, portable x-ray, community mental health and OPT.

Note: If this action is a CHOI, the documents above are the only documents you need to submit, however the Department may, at its discretion, request additional documentation in support of the CHOI. If so, you will be contacted for any of said additional documents. There is no fee for a CHOI. 

If this action is a CHOW, the following documents are also needed:

1. Does your facility have a CLIA Certificate? If yes, contact the CLIA program by clicking here.
2. *Licensing Fee: Click here for the link for the Health Standards Fee Schedule

The fee for a CHOW is usually the same as a license renewal unless the facility is making additional changes. For the providers completing an acquisition/merger, please contact the program desk for assistance.

Additional Documents Required:

1. CMS 1880 Form - https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1880.pdf

For all other Change of Ownership Information, please contact the HSS Ownership Group

Priority Exception Requests

Providers or suppliers may apply to CMS via the State Survey Agency requesting consideration for an exception to the priority assignment of the initial survey if lack of Medicare certification would cause significant access-to-care problems for beneficiaries served by the provider or supplier. There is no special form required to make a priority exception request. However, the burden is on the applicant to provide data and other evidence that effectively establishes the probability of serious, adverse beneficiary healthcare access consequences if the provider is not enrolled to participate in Medicare.